Clinical predictors of positive temporal artery biopsy

Toren, Andrew; Weis, Ezekiel; Patel, Vivek; Monteith, Bethany; Gilberg, Steven; Jordan, David R.

doi:10.1016/j.jcjo.2016.05.021

Cited by 13 publications

(17 citation statements)

References 39 publications

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“… u From 6 of the analyzed studies. v From 6 of the analyzed studies. w Limb claudication was restricted to the arms in one study and to the legs in another study.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic Accuracy of Symptoms, Physical Signs, and Laboratory Tests for Giant Cell Arteritis

et al. 2020

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“… u From 6 of the analyzed studies. v From 6 of the analyzed studies. w Limb claudication was restricted to the arms in one study and to the legs in another study.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic Accuracy of Symptoms, Physical Signs, and Laboratory Tests for Giant Cell Arteritis

et al. 2020

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“…Several prediction algorithms for GCA diagnosis have been published, 8 , 11 , 12 , 17 , 19 , 24 , 28 ( Table S3 ) with the common goal of improving diagnostic accuracy and patient selection for TABx and for reducing patient morbidity and health care expenditures. Compared to other prediction algorithms, the following are the strengths and distinguishing features of our study: Its large size, validation, and generalizability.…”

Section: Discussionmentioning

confidence: 99%

“…This clinical audit was approved by the Michael Garron Hospital Research Ethics Board and Queen’s Medical school, and was compliant with the Declaration of Helsinki and the TRIPOD guidelines. 18 Some of the data came from the de-identified records of prior research ethics board approved TABx projects (patient consent was not required by the ethics board), 19 – 22 and two centers conducted a chart review in July 2017 with patient consent. The chart review was not blinded.…”

Section: Methodsmentioning

confidence: 99%

Multivariate prediction model for suspected giant cell arteritis: development and validation

Ing¹,

Luna²,

Toren³

et al. 2017

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PurposeTo develop and validate a diagnostic prediction model for patients with suspected giant cell arteritis (GCA).MethodsA retrospective review of records of consecutive adult patients undergoing temporal artery biopsy (TABx) for suspected GCA was conducted at seven university centers. The pathologic diagnosis was considered the final diagnosis. The predictor variables were age, gender, new onset headache, clinical temporal artery abnormality, jaw claudication, ischemic vision loss (VL), diplopia, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and platelet level. Multiple imputation was performed for missing data. Logistic regression was used to compare our models with the non-histologic American College of Rheumatology (ACR) GCA classification criteria. Internal validation was performed with 10-fold cross validation and bootstrap techniques. External validation was performed by geographic site.ResultsThere were 530 complete TABx records: 397 were negative and 133 positive for GCA. Age, jaw claudication, VL, platelets, and log CRP were statistically significant predictors of positive TABx, whereas ESR, gender, headache, and temporal artery abnormality were not. The parsimonious model had a cross-validated bootstrap area under the receiver operating characteristic curve (AUROC) of 0.810 (95% CI =0.766–0.854), geographic external validation AUROC’s in the range of 0.75–0.85, calibration pH–L of 0.812, sensitivity of 43.6%, and specificity of 95.2%, which outperformed the ACR criteria.ConclusionOur prediction rule with calculator and nomogram aids in the triage of patients with suspected GCA and may decrease the need for TABx in select low-score at-risk subjects. However, misclassification remains a concern.

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“…Al comparar los diferentes grupos de pacientes no se hallaron predictores de positividad de la biopsia. Estudios previos han observado una mayor prevalencia de claudicación mandibular en los pacientes con biopsia positiva [11][12][13][16][17][18][19] . Smetana et al analizaron 2680 pacientes en un metanálisis realizado con el objetivo de demostrar variables clínicas predictoras de positividad de la biopsia, encontrando dos características clínicas que tenían un coeficiente de probabilidad positivo con poder suficiente para ser útil para el diagnóstico: la claudicación mandibular (4,2) y diplopía (3,4) 21 .…”

Section: Discussionunclassified

Resultados anatomoclínicos de las biopsias de arteria temporal realizadas en un hospital universitario de Argentina

Torre

Kostianovsky

Pisoni

2020

Rev Fac Cien Med Univ Nac Cordoba

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Introducción: La arteritis de células gigantes (ACG) es la vasculitis sistémica primaria más frecuente en pacientes mayores de 50 años. El diagnóstico de ACG se basa en la evaluación clínica, de laboratorio y estudios por imágenes, asociados a una biopsia. Sin embargo, el resultado de la biopsia puede no ser concluyente en más del 40% de los casos. El objetivo de este estudio fue revisar el manejo de los pacientes con sospecha de ACG en el hospital universitario CEMIC en Buenos Aires, Argentina, y correlacionar el comportamiento de la enfermedad con el resultado de la biopsia de arteria temporal (BAT). Métodos: Estudio retrospectivo que analizó pacientes consecutivos a los cuales se les realizó BAT en un período de 11 años (2005-2016). La información recolectada se obtuvo a partir de las historias clínicas y de los informes de anatomía patológica. Se realizó estadística descriptiva. Para las variables cuantitativas se estimaron medias y sus respectivos desvíos estándar o medianas y percentil 25-75, y para las variables cualitativas, la cantidad y el porcentaje. Para comparar las características de los grupos se realizaron análisis bivariados mediante tablas de contingencia y modelos de regresión logística de ser necesario. Resultados: Sesenta y tres pacientes fueron incluidos, 68% mujeres, con una edad media de 72 años (DS 8,4). Diecisiete biopsias (26,9%) fueron positivas. La longitud media posfijación fue de 1,68 cm (DS 1,2). La población se dividió en 3 grupos según la BAT, los criterios ACR y los estudios por imágenes. No se identificaron factores predictores de positividad de la BAT. El grupo con ACG y BAT negativa presentó mayor porcentaje de pacientes con arteria temporal anormal al examen físico. Conclusión: El porcentaje de positividad de las biopsias (26,9%) fue similar al reportado por otras series, así como la longitud de la biopsia luego de la fijación (1,68 cm). No identificamos factores predictores de positividad de la BAT.

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Clinical predictors of positive temporal artery biopsy

Cited by 13 publications

References 39 publications

Diagnostic Accuracy of Symptoms, Physical Signs, and Laboratory Tests for Giant Cell Arteritis

Diagnostic Accuracy of Symptoms, Physical Signs, and Laboratory Tests for Giant Cell Arteritis

Multivariate prediction model for suspected giant cell arteritis: development and validation

Resultados anatomoclínicos de las biopsias de arteria temporal realizadas en un hospital universitario de Argentina

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